Open Surgical Repair for the Removal of an Atrial Septal Amplatzer™ Device Eroding the Aortic Root
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The Amplatzer™ Septal Occluder is a minimally invasive device used to treat atrial septal defects (ASD). Despite the low associated complication rates, the Amplatzer™ device has, on rare occasions, been found to erode surrounding structures. The authors describe a case in which a patient presented with an aortic root fistula and underwent open surgical repair to remove an Amplatzer™ device that had been percutaneously inserted nine years earlier to repair an ostium secundum ASD.
A 33-year-old woman presented for evaluation of device erosion into the aortic root, with continuous blood flow between the aorta and right atrium consistent with a fistula. The patient underwent elective surgical repair via a median sternotomy to remove the Amplatzer™ device from the atrial septum. Exploration revealed a fistula from the noncoronary sinus of the aortic root into the right atrium. Repair consisted of removing the device, replacing the aortic wall of the entire noncoronary sinus and the right atrial wall with bovine pericardium, and replacing the atrial septum with autogenous pericardium.
The patient had an uneventful recovery with no complications—including no dysrhythmia or heart block—and was discharged on postoperative day six. Postoperative transesophageal echocardiography showed no postrepair shunt from the noncoronary sinus to the right atrium and an entirely competent aortic valve. The patient has returned to work and remains well five months after the procedure.
Although complications are uncommon after closure of an ASD with an Amplatzer™ Septal Occluder, the device may erode surrounding structures and produce a fistula. Such complications can be successfully repaired with extensive open surgical techniques.
This educational content was originally presented during the STSA 64th Annual Meeting. This content is published with the permission of the STSA. For more information on the STSA and its next Annual Meeting, please click here.